Student Admission Application
Student's Basic Information
Student's Name
*
First Name
Last Name
Student's Date of Birth
*
-
Month
-
Day
Year
Date
Student's Gender
*
Please Select
Male
Female
Unspecified
Student's Race
Please Select
Not Specified
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Home Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
What grade level will your child be during the 2026-2027 school year?
*
Please upload a copy of your child's birth certificate.
*
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Parent/Guardian Information
*
Preferred email address to receive Microschool America information.
*
example@example.com
Does your child have siblings currently enrolled in a Microschool America Forge? If yes, please provide siblings' name(s).
Student Needs and Preferences
In which Learning Forge are you most interested?
*
Please Select
Coushatta, Louisiana
Baton Rouge, Louisiana
Central Louisiana
Gonzales, Louisiana
Shreveport, Louisiana
Virtual
Please list any medical, developmental, neurological, or psychological diagnoses your child has received (e.g. cerebral palsy, hearing impaired, down syndrome, other genetic disorder, intellectual disability, specific learning disability i.e. dyslexia, dysgraphia). If none please indicate none. This information helps us determine appropriate placement and support within our program.
*
Does your child require any general/specific modifications or accommodations in the classroom? If yes please explain.
Does your child have a 504 Plan, IEP Plan, or any other specialized learning plan? If so, please upload.
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Is your child applying specifically for the special education program (Cornerstone Classroom)? Please note the Cornerstone Classroom is not available at all locations.
*
Please Select
Yes
No
Has your child previously attended a Special Needs program? If yes please list the programs.
*
Please Select
Yes
No
Please List
*
Does your child have an evaluation from an LPSS or a private psychiatrist? If yes, please list the diagnosis.
*
Please Select
Yes
No
Please list
*
Does your child currently receive any services or support? (Examples: Speech therapy, occupational therapy, counseling, behavioral therapy, resource therapy, etc) If yes, which therapy or support and how often.
*
Please Select
Yes
No
Please list
*
Is your child independently toileting?
*
Is your child independently feeding?
*
Does your child use any communication support or device? If yes, please describe.
*
Please Select
Yes
No
Please describe
*
What level of adult support does your child require throughout the day?
*
Independent with minimal prompting
Frequent redirection
Small group support
1:1 Support for portions of the day
Full 1:1 supervision
Has your child ever shown characteristics of the following? Mark all that apply:
*
Elopement/wandering
Aggression towards peers
Aggression towards adults
Impulsivity
Self-injury
Difficulty with boundaries
Medical alerts
Not Applicable
Does your child nap or require rest periods during the day?
*
Please Select
Yes
No
Does your child have known triggers in social settings? If yes please explain.
*
Please Select
Yes
No
Please explain.
*
Is your child currently on medication that affects attention, behavior, or mood? If yes, please list medication and dosing schedule during school hours
*
Please Select
Yes
No
Please list medication and dosing schedule during school hours.
*
By checking each box below, I acknowledge and agree to the following:
*
I understand that submission of this application is only the first step in the Cornerstone Program application process and does not guarantee acceptance, placement, or continued enrollment.
I understand that placement decisions are made at the discretion of Microschool America and independent Forge Operators based on the school’s determination of appropriate fit, safety considerations, and the school’s current staffing model, resources, and classroom structure.
I understand that after submission of this application, I will be contacted by a school representative to schedule an in-person meeting as part of the evaluation process.
I authorize Microschool America and applicable representatives to contact my child’s current and/or previous teachers, aides, therapists, administrators, medical providers (as applicable), and other relevant professionals for the purpose of obtaining educational, behavioral, therapeutic, and reference information to assist in determining appropriate placement.
I understand that failure to disclose relevant medical, developmental, behavioral, or educational information, or providing incomplete or inaccurate information, may result in denial of admission or dismissal from the program.
I understand that if at any time independent Forge operators determine that they cannot safely or appropriately meet my child’s needs within its current structure, the school reserves the right to deny placement or discontinue enrollment.
Why are you interested in Microschool America for your child?
What are the most important goals for your child this upcoming year?
Academic Progress
Social Skills Development
Confidence and Acceptance
Overcoming Specific Challenges
Improved Engagement and Joy in Learning
Student Interests and Background
What subjects or activities is your child passionate about?
Does your child have any extra-curricular interests (e.g. sports, music, art, STEM)?
What challenges, if any, has your child experienced in a traditional school setting?
Please upload a copy of your child's report card/transcript (if applicable) if they attended a public or private school last year.
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Enrollment and Commitment
How did you hear about Microschool America?
Do you have any questions or concerns about Microschool America?
Is your child's enrollment contingent on your child receiving state ESA funds? *The ESA in Louisiana is the GATOR scholarship, while the ESA program in Arkansas is the Arkansas Educational Freedom Account (EFA).
*
Yes, I will need ESA funding to enroll.
No, I will private pay if we don't receive the ESA.
No, we are not applying for the ESA and will private pay.
Submit
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